Treatment of ischemia due to “steal” by arteriovenous fistula with distal artery ligation and revascularization

Schanzer, Harry; Schwartz, Myron; Harrington, Elizabeth B.; Haimov, M

doi:10.1016/0741-5214(88)90040-7

Cited by 127 publications

(145 citation statements)

References 9 publications

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“…[12][13][14][15][16] Schanzer later published a series of 14 cases in 1992 and 23 cases in 1996. In the last series, all 23 patients showed clinical improvement of their dialysis-associated ischemic symptoms and demonstrated a 95.6% patency at 2 years.…”

Section: The Dril Proceduresmentioning

confidence: 99%

Distal Revascularization and Interval Ligation: A Primer for the Vascular and Interventional Radiologist

Regalado

Navuluri²,

Vikingstad³

2009

Semin intervent Radiol

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Dialysis-associated steal syndrome is a clinically significant complication associated with the creation of dialysis grafts or fistulae. The distal revascularization and interval ligation (DRIL) procedure is a surgical procedure, which has been used to treat patients with hand ischemia secondary to arterial ''steal'' from dialysis accesses. This article will review the dialysis-associated steal syndrome and the history, anatomy, and clinical results of the DRIL procedure.

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Section: The Dril Proceduresmentioning

confidence: 99%

Distal Revascularization and Interval Ligation: A Primer for the Vascular and Interventional Radiologist

Regalado

Navuluri²,

Vikingstad³

2009

Semin intervent Radiol

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“…Os fatores que determinam a presença de isquemia são: a capacidade de uma artéria proximal de entregar sangue a uma FAV, o tamanho e o comprimento da FAV e a adequação das colaterais 3 .…”

Section: Discussionunclassified

“…A "síndrome do roubo" sintomática acontece em 1 a 8% 2 dos acessos, sendo seus fatores preditivos a fístula arteriovenosa (FAV) que utiliza a artéria braquial como doadora, sexo feminino, idade maior de 60 anos, diabetes e doença vascular periférica 2,3 .…”

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“…Em 1988, Schanzer et al 3 descreveram a técnica de revascularização distal com ligadura arterial -distal revascularization-interval ligation (DRILL) -em três casos com excelente resultado. A técnica descrita pelo autor consiste em interposição de substituto arterial com tomada proximal na artéria braquial, 5 cm antes da anastomose da FAV, tomada distal próximo da bifurcação da artéria braquial e ligadura da artéria braquial logo abaixo da anastomose da FAV, com a finalidade de se evitar o fluxo reverso distal.…”

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Tratamento cirúrgico da "síndrome do roubo" em acesso vascular para hemodiálise com revascularização distal e ligadura arterial

Linardi

Bevilacqua

et al. 2006

J. vasc. bras.

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OBJETIVO: O propósito do trabalho é apresentar o resultado do tratamento da "síndrome do roubo", sintomática em acesso vascular para hemodiálise, utilizando a técnica da revascularização distal com ligadura arterial. PACIENTES E MÉTODOS: No período de dezembro de 2003 a novembro de 2004, quatro pacientes que apresentaram síndrome do roubo sintomática em acesso vascular para hemodiálise foram submetidos à revascularização distal com ligadura arterial e acompanhados até dezembro de 2005. Os quatro pacientes apresentavam dor de repouso, e dois casos evoluíram para lesão trófica. RESULTADOS: Todos os casos apresentaram regressão dos sintomas, com cicatrização das lesões tróficas e manutenção do acesso vascular, que continuou sendo utilizado para realização de sessões de hemodiálise. CONCLUSÕES: Concluímos que, atualmente, o tratamento de escolha da síndrome do roubo sintomática é a revascularização distal com ligadura arterial, pois, além de tratar a isquemia do membro, mantém o acesso vascular funcionante.

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“…The surgical techniques described to date are distal revascularization and interval ligation (DRIL) (7,8), proximalization of the arterial inflow (9), the revision using distal inflow technique (RUDI) (10), banding (11) and plication (12) techniques. Banding is a simple technique to reduce fistula flow however it is associated with thrombosis of the AVF (2).…”

Section: Introductionmentioning

confidence: 99%

Stenotic ligature: a simple technique for managing distal hypoperfusion ischemic syndrome following arteriovenous fistulas

Roata¹,

Moroşanu²,

Makkai-Popa³

et al. 2018

J Clin Invest Surg.

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Introduction. Distal Hypoperfusion Ischemic Syndrome (DHIS) is a multifactorial debilitating condition causing peripheral ischemia and potentially tissue necrosis. In an effort to further refine its surgical treatment we aim to describe a modified, simple and reliable technique for managing DHIS in patients with arteriovenous fistulas.Materials and Methods. Twenty-nine consecutive patients with DHIS operated by a single surgical team over a period of 7 years were included in the study. All patients underwent the same surgical technique: stenotic ligature. Outcomes were analyzed clinically and the effectiveness of the procedure was proven using McNemar test. Clinical variables were statistically analyzed in SPSS 17.0 for Windows.Results. The technique we used consists in performing a stenosing ligature on the vein, using a 0-silk suture, and adjusting the suture in order to achieve either a radial pulse or capillary pulse, while maintaining a good thrill at palpation of the vein. The procedure was successful in 83% of patients proved by immediate symptomatic relief. Paired data analysis showed significant decrease of all symptoms: cold extremity (p=0,021), paraesthesia (p<0,001), pain (p<0,001). History of coronary artery disease, arteriopathy or the absence of radial pulse is statistically correlated with an increased risk of developing DHIS.Conclusions. Stenotic ligature is a simple, cheap and reliable technique for managing DHIS with lower septic risks which can be easily performed under local anesthesia.

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Treatment of ischemia due to “steal” by arteriovenous fistula with distal artery ligation and revascularization

Cited by 127 publications

References 9 publications

Distal Revascularization and Interval Ligation: A Primer for the Vascular and Interventional Radiologist

Distal Revascularization and Interval Ligation: A Primer for the Vascular and Interventional Radiologist

Tratamento cirúrgico da "síndrome do roubo" em acesso vascular para hemodiálise com revascularização distal e ligadura arterial

Stenotic ligature: a simple technique for managing distal hypoperfusion ischemic syndrome following arteriovenous fistulas

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